Caregiver Expressed Emotion and Psychiatric Symptoms in African‐Americans with Schizophrenia: An Attempt to Understand the Paradoxical Relationship

• Author: Kayla Gurak,Amy Weisman de Mamani
• Date: 01 June 2017
• DOI: http://doi.org/10.1111/famp.12188
• Published date: 01 June 2017

Caregiver Expressed Emotion and Psychiatric

Symptoms in African-Americans with Schizophrenia:

An Attempt to Understand the Paradoxical

Relationship

KAYLA GURAK*

AMY WEISMAN DE MAMANI*

Expressed emotion (EE) is a family environmental construct that assesses how much

criticism, hostility, and/or emotional over-involvement a family member expresses about a

patient (Hooley, Annual Review of Clinical Psychology, 2007, 3, 329). Having high levels of

EE within the family environment has generally been associated with poorer patient out-

comes for schizophrenia and a range of other disorders. Paradoxically, for African-American

patients, high-EE may be associated with a better symptom course (Rosenfarb, Bellack, &

Aziz, Journal of Abnormal Psychology, 2006, 115, 112). However, this finding is in need of

additional support and, if confirmed, clarification. In line with previous research, using a

sample of 30 patients with schizophrenia and their primary caregivers, we hypothesized

that having a caregiver classified as low-EE would be associated with great er patient

symptom severity. We also aimed to better understand why this pattern may exist by exam-

ining the content of interviews taken from the Five-Minute Speech Sample. Results sup-

ported study hypotheses. In line with Rosenfarb et al. (2006), having a low-EE caregive r

was associated with greater symptom severity in African-American patients. A content

analysis uncovered some interesting patterns that may help elucidate this finding. Results

of this study suggest that attempts to lower high-EE in African Americans may, in fact, be

counterproductive.

Keywords: African Americans; Schizophrenia; Expressed Emotion; Content Analysis;

Communication Patterns

Fam Proc 56:476–486, 2017

Expressed emotion (EE) is a psychosocial construct that assesses the emotional climate

of the family environment by measuring the extent to which family members make

critical, hostile, or emotionally over-involved (EOI) statements when speaking abo ut the

patient (Hooley, 2007; Kopelowicz et al., 2002). Having high levels of EE in the family

environment is widely recognized as a robust environmental risk factor for relapse and

exacerbation of the illness (Cutting, Aakre, & Docherty, 2006; Hooley & Gotlib, 2000; Lin-

szen et al., 1997), across numerous countries and cultures (Bhugra & McKenzie, 2003;

Hashemi & Cochrane, 1999). However, there are several findings within the schizophrenia

literature that point to different patterns of EE based on one’s ethnicity. For example, sev-

eral papers have documented key differences in Hispanic/Latino and Caucasian patients

*Department of Psychology, University of Miami, Coral Gables, FL.

Correspondence concerning this article should be addressed to Kayla Gurak, Department of Psychology,

University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL 33146. E-mail: kayla.gurak@gmail.com.

Special thanks to Erin Fischer for her assistance with this project.

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Family Process, Vol. 56, No. 2, 2017 ©2015 Family Process Institute

doi: 10.1111/famp.12188